Risk of Thromboembolic Complications and Antithrombotic Therapy in in-Patients With Permanent and Recurrent Atrial Fibrillation in Real Clinical Practice

Aim. To study the current state of the anticoagulant's prescription in elderly and senile patients with atrial fibrillation in the clinical practice of family medicine center, in the southern regions of the Kyrgyz Republic.Material and methods. Of the 1974 ambulatory medical observation cards, 470 patients with atrial fibrillation were selected who had indications for prescribing antithrombotic therapy (87 [18.5%] men and 383 [81.5%] women; 212 [45.1%] urban residents and 258 [54.9%] rural residents). The average age was 66.9±10.2 years. The analysis included data from 387 patients who received anticoagulant therapy. The frequency of prescribing antithrombotic therapy has been studied.Results. There were indications for anticoagulant therapy in 387 patients. Anticoagulants were taken by 167 (43.2%) patients, antiplatelet agents - 196 (50.6%), no therapy - 24 (6.2%). Anticoagulant therapy in 153 patients included warfarin, while only 11.8% had adequate INR control after one year of follow-up. Rivaroxaban was prescribed in 14 (8.4%) patients. 50% of patients had antiplatelet agents instead of anticoagulants, which were mainly prescribed by therapists of rural family medicine centers.Conclusion. In the southern regions of the republic, an unfavorable situation is observed with the prescription and management of elderly and senile patients on anticoagulant therapy. It is necessary to continue the research across the country in order to obtain a complete and real picture of the problem, and to develop a unified and relevant recommendation.

Section: Discussionunclassified

Analysis of Anticoagulant Therapy in the Elderly Patients, in Clinical Practice of Family Medicine Centers in the Kyrgyz Republic

Mamatov

кyzy

Musakeev

et al. 2021

“…В группе пациентов с ФП без ИМ вопросы назначения ОАК решаются более просто, нежели у пациентов с сочетанием ФП и ИМ, но частота назначения ОАК является недостаточной, хотя и увеличивается на протяжении последних нескольких лет. Так, в ретроспективном анализе 308 историй болезни пациентов, госпитализированных в отделения неотложной кардио-логии двух многопрофильных стационаров г. Саратова с 1 января 2008 г. по 31 декабря 2009 г. частота назначения ОАК составила 32,2% [18]. По данным ретроспективного исследования 677 историй болезни пациентов с ФП, лечившихся в Университетской клинической больнице №1 Первого Московского государственного медицинского университета имени И.М.…”

Section: Discussionunclassified

Antithrombotic Therapy in Patients with Atrial Fibrillation after Myocardial Infarction: Clinical Guidelines and Actual Practice

Переверзева

Yаkushin

Pripadcheva

et al. 2019

Aim. To study the frequency of oral anticoagulants (ОАС) prescription for patients with atrial fibrillation (AF) after myocardial infarction (MI). Material and methods. The study includes 106 patients (60 men, 55.6%) with a previously established diagnosis of AF, who were on hospital treatment in the period 2016-2017 years in one of the university hospitals of the city and having at the time of discharge from the hospital the final diagnosis of МI. The median age was 70.0 (61.0;78.0) years. Patients with the first and only paroxysm of AF were excluded from the analysis and all further calculations were performed for 104 patients. In 64 (60.2%) of cases, AF was presented by paroxysmal form, while in 2 (1.9%) cases this paroxysm was the first and only, in 20 (18.9%) cases – persistent AF and in 20 (18.9%) – pernanent. Results. While assessing the risk of thromboembolic complications on the CHA2DS2-VASc scale, the median score for all patients was 5.0 (4.0;6.0) points. While assessing the risk of hemorrhagic complications on the HAS-BLED scale, the median score for all patients was 2.0 (2.0;3.0) points. HAS-BLED≤2 value had 71 (68.3%) patients, HAS-BLED≥3 – 33 (31.7%). Only one antiplatelet agent was prescribed to 4 (3.8%) patients. Aspirin was the only antiplatelet agent in 3 cases and clopidogrel – in one case. In 80 (76.9%) cases, patients were prescribed dual antiplatelet therapy, in 17 (16.3%) – ОАС therapy, among which 7 (6.7%) cases – a triple antithrombotic therapy (ATT), 9 (8.7%) cases – a double ATT (ОАС+ antiplatelet agent) and 1 (1.0%) case – a monotherapy. Among all cases of OAC prescription warfarin was prescribed in 11 (64.7%) cases and rivaroxaban – in 6 (35.3%). Conclusion. In real clinical practice, the prescription or refusal of ОАС occurs without taking into account the risk of thromboembolic and hemorrhagic complications according to appropriate scales.

“…и 2008-2009 г, опубликованным И.В. Грайфер [27], демонстрируют, что частота назначения ОАК по показаниям за 10 лет сохранилась примерно на том же уровне, и составляет менее 30%. Частота назначения АВК снизилась в среднем на 10%, и главным образом в реальной клинической практике применяются ПОАК.…”

Section: материал и методыunclassified

Changes in Antithrombotic Therapy of Atrial Fibrillation in the Hospital in 2011-2012 and 2016-2017 (Pharmacoepidemiological Analysis)

Reshetko

Соколов

Furman

et al. 2020

Self Cite

Aim. To study the changes that have occurred in the pharmacotherapy of atrial fibrillation (AF) in the Saratov Region for 5 years by analyzing the antithrombotic therapy of patients who were admitted in a specialized department of the multidisciplinary hospital in Saratov in 2011-2012 and in 2016-2017.Material and methods. A pharmacoepidemiological retrospective study was conducted. The object of the study was the medical records of inpatients (Form 003/y) with the diagnosis “Atrial fibrillation” (ICD-X code I48), that consecutively admitted to the cardiology department of the multidisciplinary hospital in Saratov from January 1, 2011 to December, 31, 2012 (n=211) and from January 1, 2016 to December, 31, 2017 (n=227). Criteria for inclusion in the study: patients over 18 years of age, established diagnosis of non-valvular AF of ischemic genesis. Exclusion criteria from the study: non-ischemic cardiomyopathy, thyrotoxicosis, congenital heart defects, rheumatic heart damage, acute coronary syndrome, endocarditis, myocarditis, pericarditis, pulmonary thromboembolism, the presence of prosthetic heart valve. Pharmacoepidemiological analysis was carried out for the drugs prescribed during hospitalization and given by doctors at discharge of patients from the hospital. The risk of ischemic stroke was assessed using the CHA2DS2-VASc score, and the risk of bleeding – according to the HAS-BLED score.Results. When analyzing the risk of ischemic stroke, it was found that 100% of patients in 2011-2012 years and 98.2% in 2016-2017 years had indications for the prescription of oral anticoagulants (OAСs). In 2011-2012 there were no patients with a low risk of stroke (CHA2DS2-VASc=0). High risk of bleeding (HAS-BLED≥3) occurred in 4.7% of patients in 2011-2012 and in 10.6% in 2016-2017, however, due to the high risk of stroke, the refusal to prescribe OAC in these patients was inappropriate in accordance with the recommendations for the treatment of AF. In the group of patients with CHA2DS2-VASc=0 in 2016-2017 antiplatelet therapy was prescribed in 100% at the hospital stage and at discharge, which contradicts the guidelines, according to which antithrombotic therapy is not recommended to patients with CHA2DS2-VASc=0. In patients with CHA2DS2-VASc=1, a low percentage of anticoagulants prescription was noted. In 2016-2017 OACs were prescribed only in 12.5% of patients at all stages of observation. In 2011-2012 OAC alone was prescribed only to 1 person (20%) at the hospital stage, which does not comply with modern guidelines for the treatment of patients with AF, according to which patients with a risk score CHA2DS2-VASc=1 are recommended to receive OACs in the absence of contraindications. OACs prescription in group CHA2DS2-VASc≥2 occurred only in 15% of patients in 2011-2012 and in a third of patients in 2016-2017 (p<0.05). The frequency of isolated use of OACs significantly increased in 2016-2017 compared to 2011-2012 mainly due to the increase in the spectrum of direct OACs (DOACs) (p<0.05).Conclusion. For 5 years there have been significant changes in the antithrombotic therapy of AF in the Saratov Region. The frequency of prescribing OACs according to indications has increased mainly due to the introduction of the DOACs into clinical practice. However, prevention of stroke remains insufficient.